Joseph R. Anticaglia, MD
Medical Advisory Board
One of the things we take for granted is a good voice, one that is strong, easily understood and of good quality. We have a problem when a voice disorder interferes with our ability to communicate with family and friends, or to earn a living.
As we get older, our voice can change. People, in their sixties or older, can experience changes in the voice box (larynx), or vocal tract (see below) that can affect the loudness, pitch and the overall quality of sound.
The voice box (larynx) is made of muscle, mucosa, and cartilage. It is located behind the Adam’s Apple. The vocal folds, or vocal cords contain muscle and mucosa. The vocal folds vibrate when air pressure generated by the lungs moves upward through the windpipe (trachea) to the undersurface of the vocal folds.
The air pressure from the lungs, as noted, causes the vocal folds to vibrate which results in a buzzing sound, not speech. The air pressure and sound waves continue above the vocal folds along the vocal tract which includes the throat, mouth, and nasal cavity. The vocal track shapes the buzzing sounds into speech sounds which eventually becomes recognizable words.(see diagram below).
The elderly patients may have complaints about their:
Two fundamental factors contribute to voice changes in the aging voice. One involves the vocal folds of the larynx which make the initial buzzing, voice sound; the other factor involves the lungs which generate air pressure that powers the voice.
As one gets older, the sound of the voice may become weak and abnormal because:
Age-related medical conditions can affect vocal function. For example, emphysema, chronic obstructive pulmonary disease, COPD, or asthma may decrease the projection, strength, smoothness and fluency of a person’s voice.
It’s necessary to rule out other causes of voice changes in the elderly. Several conditions that can affect the voice include vocal fold nodules, polyps, vocal fold cancer, vocal fold paralysis, and neurological disorders. A thorough evaluation by a physician such as an otolaryngologist (ear, nose, and throat specialist) is necessary to determine the exact cause.
The changes in the aging voice may impact self-esteem, confidence, and social interactions. Some individuals may experience frustration, embarrassment, isolation, or a sense of loss due to changes in their voice. People have found psychological counselling useful in these circumstances.
The aging voice alone is not a common occurrence. Treatment depends on making an accurate diagnosis of this condition after excluding other problems like vocal nodules or vocal polyps.
Speech therapy offered by speech-languages pathologists, can provide vocal exercises and techniques to improve vocal function, breath control and the quality of your voice. Medical treatment of menopausal women experiencing voice changes due to hormonal fluctuations may benefit with estrogen replacement treatment.
Phonosurgery is any procedure designed to improve or restore voice quality. Such surgery uses an operating microscope with micro-instrumentation to evaluate and manage any pathology that involves the vocal folds and larynx.
Vocal Cord Injection is a surgical procedure in which a filling agent is injected into the area of the vocal fold that lacks bulk as in vocal fold bowing, or lack of movement as in vocal fold paralysis.
Whether we’re young or old, lack of proper exercise will eventually lead to muscle atrophy. As we get older, muscle atrophy can happen insidiously in the larynx as well. If you’re older, you might talk less because you live alone, are depressed or you’re not socially engaged.
Consider exercising the laryngeal muscles daily by becoming more active socially, reading out loud at home, and as strange as it may seem to some, by singing your favorite songs. Also, stay hydrated, eat nutritiously, avoid smoking, and have regular check-ups with your doctor to stay healthy.
Most often elderly people don’t experience voice changes solely due to aging. If you’re concerned about changes in your voice that last more than several weeks, it’s best to have your larynx examined by a specialist to determine the diagnosis and the best treatment
Presbylaryngis happens when the muscles in the vocal folds atrophy (shrink) and curve inward causing a bowing of the larynx seen in the elderly and aging voice.
Presbyphonia is a condition that happens when changes in the larynx cause poor vocal quality, such as reduced vocal stamina, difficulty projecting one’s voice, or reduced volume.
Dysphonia — change in the quality of the voice when trying to talk, for instance hoarseness.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.
